Finance Program #2 Secure Application

CONTACT INFORMATION

Complete Legal Name:
Billing Address:
City:
County
State:
Zip Code:
Daytime Phone:
E-mail:
Contact:

LOAN/LEASE REQUEST

Total $ Amount:
Equipment Description:
Vendor/Supplier:
Address:
City:
County
State:
Zip Code:
Daytime Phone:
E-mail:
Contact:

TYPE OF BUSINESS

Non Profit    Sole Proprietorship    Partnership    Corporation

# of years in business under current owner:

LOCATION OF PROPERTY (if other than Billing Address of Lessee)

Street Address:
City:
County
State:
Zip Code:

PERSONAL INFORMATION ON OFFICERS, PARTNERS OR GUARANTORS

Name:
Title:
Social Security #:
Home Phone:
Home Address:
City:
County
State:
Zip Code:

Are you a US Citizen? Yes     No

(if no, explain status):

BUSINESS/PERSONAL BANK REFERENCES - TWO YEAR HISTORY (important to establish any loan history - attach copies of bank statements)

Name of Bank/Branch:
How Long:
Telephone Number:
Contact:
Checking Account #:
Savings Account #:
Loan Account #:

 

Name of Bank/Branch:
How Long:
Telephone Number:
Contact:
Checking Account #:
Savings Account #:
Loan Account #:

TRADE REFERENCES - TWO YEAR HISTORY (important to establish high credit and payment history)

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

Name of Supplier:
City:
State:
Telephone Number:
Contact:

BUSINESS LANDLORD/MORTGAGEE - TWO YEAR HISTORY (important to establish high credit and payment history)

Company Name:
Contact:
Telephone Number:

Insurance Company:
Contact:
Telephone Number:
Referred by:
Express Equipment Finance Account Manager:
Cover Letter
(Explanation of reason for funding)

Personal Financial Statement

Principal #1
Name:
Address:
City, State, Zip:
Social Security #:
Date of Birth:
Position or Occupation:  
Business Name:
Bus. Address:
City, State, Zip:
Length at present employment:
Length of employment:
 
Principal #2 (if applicable)
Name:
Address:
City, State, Zip:
Social Security #:
Date of Birth:
Position or Occupation:
Business Name:
Bus. Address:
City, State, Zip:
Length at present employment:
Length of employment:
 
Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled for debts for less that the amounts owed? If yes, please provide details by clicking here.
No
Yes
When
Are (either of) you a defendant in any suit or legal action?
No
Yes
When
Are (either of) you presently subject to any unsatisfactory judgments or tax liens?
No
Yes
When
When, if ever, have (either of) you been audited by IRS?
No
Yes
When
ASSETS
IN EVEN DOLLARS
ASSETS
IN EVEN DOLLARS
Cash on Hand
Marketable Securities -
See Schedule A
Non-Marketable Securities -
See Schedule B
Securities held by Broker in
Margin Accounts
Restricted or Control Stocks
Partial Interest in Real Estate
Equities
Partnership Interest -
See Schedule C
Real Estate Owned -
See Schedule D
Loans Receivable
Automobiles and Other Personal
Property
Other Assets - Itemize
 
 
 
 
Total Assets

LIABILITIES
IN EVEN DOLLARS
LIABILITIES
IN EVEN DOLLARS

Notes Payable to Banks
See Schedule F
Due to Brokers
Amounts Payable to Others
See Schedule F
Loans on Life Insurance -
See Schedule E
Accounts and Bills Due
Unpaid Income Tax
Other Unpaid Taxes and Interest
Real Estate Mortgages Payable
See Schedule D
Other Debts - Itemize
 
 
 
 
Total Liabilities
 
Net Worth
Total Liabilities & Net Worth
ANNUAL SOURCE OF INCOME
Salary, Bonus & Commissions
Dividends
Real Estate Income
Less Living Expenses
TOTAL
 
Net Income
 
CONTINGENT LIABILITIES
Do you have any Contingent
Liabilities
As Endorser, Co-Maker, or Guarantor
On Leases or Contracts
Legal Claims
Other Special Debt
Amount of Contested Income
Tax Liens

Financial Schedules

SCHEDULE A - U.S. GOVERNMENTS AND MARKETABLE SECURITIES
No. of Shares or Face Value (Bonds)
Description
In Name Of
Market Value
Where Pledged
SCHEDULE B - NON MARKET SECURITIES
Description of Securities
In Name Of
No. of Shares Owned
Book Value Per Financial Statement
Dated
No. of Shares Outstanding
Where Pledged

 

 

 

 
SCHEDULE C - PARTIAL INTEREST IN REAL ESTATE EQUITIES OR PARTNERSHIP INTERESTS
Location of Property or Name of Partnership
Owner of Record
% of Ownership
Type
Year of Purchase
Cost
Market Value
Mortgage or Land Contract
Value of Equity
SCHEDULE D - REAL ESTATE OWNED
Description of Property or Name of Partnership
Date Acquired
Title in Name Of
Cost
Market Value
Mortgage or Land Contract
Annual Net Cash Flow
Annual Payment Amount
SCHEDULE E - LIFE INSURANCE CARRIED, INCLUDING GROUP INSURANCE
Face Amount
Name of Company
Owner
Beneficiary
Cash Surrender Value
Loans
SCHEDULE F -NAME OF BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED
Name and Address
Original Date
High Credit
Owe Currently
Secured or Unsecured

If your application for business credit is denied, you have the right to a written statement of the specific reason(s) for denial. To obtain the statement, please contact Express Equipment Finance, Scottsdale, AZ, 85260, 1-866-353-2731 within 60 days from the date of our decision. We will send you a written statement of the reason(s) for the denial within 30 days of receiving your request for the statement.

NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act, the federal agency that administers compliance with this law concerning this credit is the Federal Deposit Insurance Corporation, 25 Ecker Street, Suite 2300, San Francisco, CA.

By clicking on the SUBMIT button below, I certify that the above given information given for the purpose of obtaining credit is true and correct. I authorize the person or firm to whom this application is made, any credit bureau or investigative agency employed by such person to investigate the references herein listed or other persons pertaining to my credit. I understand the terms of this instrument are not binding on Express Equipment Finance until accepted in writing by them.

 

Remember to Fax or Mail:
Last 2 years personal tax returns
Current business financial statement and/or projection on new business
Resume on all key principals

TO:
Express Equipment Finance
14700 N. Frank Lloyd Wright
Suite 157, PMB 255
Scottsdale, AZ  85260

 Fax: 1-765-352-2731